Musculoskeletal Physiotherapy Consultants

The Clinical Framework

By on February 2, 2016 in General with 0 Comments

clinical framework

When insurance companies refer a workers’ compensation case to Specialist Physiotherapy Services for an independent physiotherapy assessment, we typically contact the treating physiotherapist and have a discussion about the clinical diagnosis and ongoing management of the injured worker. This gives us much insight into what treatment has been given, what effect it has had and what might be the best approach going forward for that particular injured person. Being completely independent typically facilitates a more open and constructive conversation than sometimes may occur when the insurer speaks directly with the treating practitioner who, at times, may feel they need to defend their treatment decisions to someone with a lesser understanding. Our specialist musculoskeletal physiotherapy qualifications definitely helps too!

During our discussions, we often ask questions such as:

  • What are the functional goals which will assist a return to work?
  • What are the facilitators and barriers to return to work?
  • Is treatment progressing from passive to active interventions and self-management strategies?
  • Has the treatment been and does it continue to be effective?
  • What outcome measures are being used to demonstrate the effectiveness of treatment?

These are reasonable and obvious questions which physiotherapists should have considered in guiding patient management. Unfortunately however, it is the absence of such consideration that has often led to the case being flagged for our attention by the insurer.

Most claims advisors, case managers, etc. should be familiar with the ‘Clinical Framework for the Delivery of Health Services’.  Sadly, few physiotherapists have even heard of it. This document which was developed by the Transport Accident Commission and WorkSafe Victoria is an evidence-based guide designed to support healthcare practitioners delivering services to people with compensable injuries. It is supported by the Australian Physiotherapy Association and endorsed by  most workcover and motor vehicle accident authorities in Australia including WorkCover WA.

It is no coincidence that the 5 questions above which we often put to treating practitioners, actually reflect the guiding principles of the Clinical Framework. Just as it takes time for results from randomised controlled trials, systematic reviews and clinical guidelines to be implemented in clinical practice, so too it is taking time for physiotherapists to become familiar with the Clinical Framework.

It is important to note that the Clinical Framework is like other clinical guidelines i.e. they are just that – guidelines. This means that they are there as a guide, a well evidenced and eminently sensible guide but a guide all the same. As each injured person is treated individually, guidelines must be flexible to accommodate individual variations and situations. What works for one person may not be the right approach for another and it is our job to advise which might be the best approach in any given case. If Physiotherapists have not followed the guidelines we will discuss with them why not and see if there is clinical evidence that, in this case, a different approach is better and proving to be more effective. If so then great, but if not then we might encourage moving towards the framework-recommended treatment. Invariably the physiotherapists are receptive to that especially when coupled with a discussion about the use of validated outcome measures to prove whether treatment is working or not.

Recently, we were pleased to see a free webinar for members of the Australian Physiotherapy Association in which Paul Coburn discussed the specific elements of the Clinical Framework. These efforts to disseminate information amongst physiotherapists is most welcome as we strive to achieve optimal outcomes in recovery and return to work.

If you’re not familiar with the Clinical Framework, a copy can be found here.



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